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Lynn Haven, FL, United States

Kalantzis G.,Florida Atlantic University | Shang C.,Florida Atlantic University | Shang C.,Lynn Cancer Institute | Lei Y.,University of Nebraska Medical Center | Leventouri T.,Florida Atlantic University
Swarm and Evolutionary Computation

Intensity modulated radiation therapy (IMRT) affords the potential to decrease radiation therapy associated toxicity by creating highly conformal dose distribution to tumor. Inverse optimization of IMRT treatment plans is often a time intensive task due to the large scale solution space, and the indubitably complexity of the task. Furthermore, the incorporation of conflicting dose constraints in the treatment plan, usually introduces an additional degree of intricacy. Metaheuristic algorithms have been proposed in the past for global optimization in IMRT treatment planning. However one disadvantage of the aforementioned methods is their extensive computational cost. One way to ameliorate their performance deficiency is to parallelize the application. In the current study we propose a GPU-based levy-firefly algorithm (LFA) for constrained optimization of IMRT treatment planning. The evaluation of our method was realized for two treatment cases: a prostate and a head and neck (H&N) cancer IMRT plans. The studies indicated an ascendable increase of the speedup factor as a function of the number of pencil beams with a maximum of ~11, whereas the performance of the algorithm was decreasing as a function of the population of the swarm particles. In addition, from our simulation results we concluded that 200 fireflies were sufficient for the algorithm to converge in less than 80 iterations. Finally, we demonstrated the effect of penalizing factors on constraining the maximum dose at the organs at risk (OAR) by impeding the dose coverage of the tumor target. The impetus behind our study was to elucidate the performance and generic attributes of the proposed algorithm, as well as the potential of its applicability for IMRT optimization problems. © 2015 Elsevier B.V. All rights reserved. Source

Fox S.A.,Florida Atlantic University | Shanblatt A.A.,Florida Atlantic University | Beckman H.,Sinai Hospital of Detroit | Strasswimmer J.,Florida Atlantic University | And 2 more authors.
Lasers in Surgery and Medicine

Background and Objectives: The number of cases of non-melanoma skin cancer (NMSC), which include squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), continues to rise as the aging population grows. Mohs micrographic surgery has become the treatment of choice in many cases but is not always necessary or feasible. Ablation with a high-poweredCO2 laser offers the advantage of highly precise, hemostatic tissue removal. However, confirmation of complete cancer removal following ablation is difficult. In this study we tested for the first time the feasibility of using Raman spectroscopy as an in situ diagnostic method to differentiate NMSC from normal tissue following partial ablation with a high-powered CO2 laser.Materials and Methods: Twenty-five tissue samples were obtained from eleven patients undergoing Mohs micrographic surgery to remove NMSC tumors. Laser treatment was performed with a SmartXide DOT Fractional CO2 Laser (DEKA Laser Technologies, Inc.) emitting a wavelength of 10.6 μm. Treatment levels ranged from 20mJ to 1200mJ total energy delivered per laser treatment spot (350μm spot size). Raman spectra were collected from both untreated and CO2 laser-treated samples using a 785nm diode laser. Principal Component Analysis (PCA) and Binary Logistic Regression (LR) were used to classify spectra as originating from either normal or NMSC tissue, and from treated or untreated tissue.Results: Partial laser ablation did not adversely affect the ability of Raman spectroscopy to differentiate normal from cancerous residual tissue, with the spectral classification model correctly identifying SCC tissue with 95% sensitivity and 100% specificity following partial laser ablation, compared with 92% sensitivity and 60% selectivity for untreated NMSC tissue. The main biochemical difference identified between normal and NMSC tissue was high levels of collagen in the normal tissue, which was lacking in the NMSC tissue.Conclusion: The feasibility of a combined high-powered CO2 laser ablation, Raman diagnostic procedure for the treatment of NMSC is demonstrated since CO2 laser treatment does not hinder the ability of Raman spectroscopy to differentiate normal from diseased tissue. This combined approach could be employed clinically to greatly enhance the speed and effectiveness ofNMSCtreatment in many cases. © 2014 Wiley Periodicals, Inc. Source

Strasswimmer J.,Lynn Cancer Institute | Strasswimmer J.,Florida Atlantic University | Latimer B.,Dermatology Associat. of the Palm Beaches | Ory S.,IVF Florida | Ory S.,Florida International University
Fertility and Sterility

Objective To report a novel mechanism suggestive of early ovarian failure secondary to the anti-tumor hedgehog-pathway inhibitor vismodegib. Design Case report and literature review. Setting Academic and private dermatology and fertility practices. Patient(s) A 34-year-old nulliparous woman with locally advanced basal cell carcinomas who became amenorrheic while receiving oral therapy with vismodegib. Intervention(s) Physical examination and endocrine evaluation. Main Outcome Measure(s) Elevated follicle-stimulating hormone (FSH) and low estrogen in the setting of a normal anti-Müllerian hormone. Result(s) FSH was elevated; estrogen was low. Preantral follicles were detected and anti-Müllerian hormone activity was normal. Menses resumed 5 weeks after cessation of therapy. Conclusion(s) Vismodegib, a first-in-class inhibitor of the hedgehog signaling pathway is indicated for advanced basal cell carcinoma and is associated with amenorrhea. The mechanism is unknown; it has some features of ovarian failure but preserves ovarian potential through blockading of FSH-receptor-dependent signal transduction. This effect appears to be rapidly reversible upon cessation of therapy. Vismodegib and related compounds may have potential for a role in intervention for gynecologic and endocrine disorders and in therapy for other issues involving FSH-dependent function. © 2014 by American Society for Reproductive Medicine. Source

Nikolaev A.,Florida Atlantic University | Benda R.,Lynn Cancer Institute
Urology Case Reports

Renal cell carcinoma (RCC) is traditionally considered to be resistant to conventional low dose radiation therapy (RT). The emergence of image-guided stereotactic body radiation therapy (SBRT) made it possible to deliver much higher doses of radiation. Recent clinical trials of SBRT for RCC showed improvement in local control rates and acceptable toxicity. Here we report a case of inoperable symptomatic RCC that was managed with SBRT. Strikingly, the presenting symptoms of gross hematuria and severe anemia were completely resolved following a course of SBRT. Thus, our case report highlights the potential benefit of this technique for patients with inoperable RCC. © 2016. Source

Mackey J.R.,Cross Cancer Institute | Martin M.,Complutense University of Madrid | Pienkowski T.,European Health Center | Rolski J.,Podkarpackie Centrum Onkologii | And 26 more authors.
The Lancet Oncology

Background: We compared standard adjuvant anthracycline chemotherapy with anthracycline-taxane combination chemotherapy in women with operable node-positive breast cancer. Here we report the final, 10-year follow-up analysis of disease-free survival, overall survival, and long-term safety. Methods: BCIRG 001 was an open label, phase 3, multicentre trial in which 1491 patients aged 18-70 years with node-positive, early breast cancer and a Karnofsky score of 80% or more were randomly assigned to adjuvant treatment with docetaxel, doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified according to institution and number of involved axillary lymph nodes per patient (one to three vs four or more). Disease-free survival was the primary endpoint and was defined as the interval between randomisation and breast cancer relapse, second primary cancer, or death, whichever occurred first. Efficacy analyses were based on the intention-to-treat principle. BCIRG 001 is registered with ClinicalTrials.gov, number NCT00688740. Findings: Enrolement took place between June 11, 1997 and June 3, 1999; 745 patients were assigned to receive TAC and 746 patients were assigned to receive FAC. After a median follow-up of 124 months (IQR 90-126), disease-free survival was 62% (95% CI 58-65) for patients in the TAC group and 55% (51-59) for patients in the FAC group (hazard ratio [HR] 0·80, 95% CI 0·68-0·93; log-rank p=0·0043). 10-year overall survival was 76% (95% CI 72-79) for patients in the TAC group and 69% (65-72) for patients in the FAC group (HR 0·74, 0·61-0·90; log-rank p=0·0020). TAC improved disease-free survival relative to FAC irrespective of nodal, hormone receptor, and HER2 status, although not all differences were significant in these subgroup analyses. Grade 3-4 heart failure occurred in 26 (3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused death in two patients in the TAC group and four patients in the FAC group. A substantial decrease in left ventricular ejection fraction (defined as a relative decrease from baseline of 20% or more) was seen in 58 (17%) patients who received TAC and 41 (15%) patients who received FAC. Six patients who received TAC developed leukaemia or myelodysplasia, as did three patients who received FAC. Interpretation: Our results provide evidence that the initial therapeutic outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant regimen are maintained at 10 years. However, a substantial percentage of patients had a decrease in left ventricular ejection fraction, probably caused by anthracycline therapy, which warrants further investigation. Funding: Sanofi. © 2013 Elsevier Ltd. Source

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